ADB Inside Site Assessment

• Crew leader/Foreman

• Personnel

• Conducted on

  Date
• Location
  Address

• Client/Site

• Weather conditions

• Hard Hats in use by personnel?

  Yes

  No

  N/A

• Eye protection in use by all personnel?

  Yes

  No

  N/A

• Reflective vest worn by all personnel?

  Yes

  No

  N/A

• Hearing protection in use when required?

  Yes

  No

  N/A

• Proper Boots?

  Yes

  No

  N/A

Tools and Equpiment

• Tools and equipment in good safety condition?

  Yes

  No

  N/A

• Extension cord grounding intact

  Yes

  No

  N/A

• Extension cord cracks, frays?

  Yes

  No

  N/A

• Ladder use, 3 points of contact at all times?

  Yes

  No

  N/A

• Inspect before use?

  Yes

  No

  N/A

• Equipment in good condition before use ? retractable, ropes, tie downs.

  Yes

  No

  N/A

• Equipment properly stored out of the way?

  Yes

  No

  N/A

• Ladders stored properly?

  Yes

  No

  N/A

• Area free for walk around access?

  Yes

  No

  N/A

• Carts being put to the side without damage?

  Yes

  No

  N/A

• Tools stored after use?

  Yes

  No

  N/A

• Safe access to the work site?

  Yes

  No

  N/A

• Good house keeping?

  Yes

  No

  N/A

• First aid kit/eye wash available ?

  Yes

  No

  N/A

• Pre-task cards reviewed by crew?

  Yes

  No

  N/A

• Fire extinguisher available?

  Yes

  No

  N/A

• Push, don't pull?

  Yes

  No

  N/A

• Turn, don't twist?

  Yes

  No

  N/A

• Squat, don't bend?

  Yes

  No

  N/A

• Load close to the body?

  Yes

  No

  N/A

• was crew open to coaching?

  Yes

  No

  N/A

• How was the crews attitude towards safety?

• List any other unsafe acts you saw on this site.

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